| NPI | 1205953452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 4406) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 4292) |
| 152W00000X Optometrist (Licence: CT 1065) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2011-05-19 |